Waiting Period in Health Insurance

What is a Waiting Period in Health Insurance?

Waiting period refers to the duration during which certain benefits or coverage are not available in a health insurance policy. Essentially, it is a time period the policyholder must wait from the policy start date to claim coverage for listed diseases and medical conditions. For instance, a waiting period of 1 to 3 years to cover pre-existing diseases is applicable in most medical insurance plans.

If the policyholder raises a health insurance claim with the insurer before the expiry of the waiting period, the insurer can reject it. However, if the policyholder raises the claim after the completion of the waiting period, the insurance company cannot deny it.

For example, if the waiting period for diabetes in health insurance for parents is 90 days and a claim is filed after 60 days, the insurer will reject it. But if the claim is filed after 90 days, it will not be denied.

Common Types of Waiting Periods in Health Insurance

Some of the most common types of waiting period in mediclaim insurance are as follows:

• Pre-existing Diseases (PED) Waiting Period: At the time of buying health insurance, if the insured has any existing ailments, like diabetes, high blood pressure, thyroid, etc., they are called pre-existing diseases (PED). Almost all medical insurance plans cover PED after a waiting period of 1 to 3 years. This implies that any medical expenses resulting from declared pre-existing illnesses can be claimed only after 1 to 3 years of successful renewals, depending on the plan.
• Waiting Periods for Specific Ailments/Procedures: Certain ailments and procedures, such as hernia, joint replacement surgery, ENT disorders, osteoporosis, cataract, etc., come with a waiting period of up to 3 years. Any medical expenses resulting from such diseases/ procedures are covered by insurance companies only after the said waiting period is over.
• Initial Waiting Period: Almost all health insurance plans have an initial waiting period of 30 days, during which no claims are accepted other than accidental cases.
• Critical Illnesses Waiting Period: All critical illness insurance plans come with a waiting period of up to 90 days. The insurer rejects any claims for listed critical illnesses received during this period.
• Maternity Benefit Waiting Period: Most health plans offer maternity insurance and newborn baby cover only after a waiting period of 3 months to 6 years is over.

The table below shows the common waiting periods associated with various conditions encountered after buying a health insurance plan:

*These are the common waiting periods, and may vary across different plans. Read your policy wording carefully to know the exact duration.

What is the Waiting Period for Heart Diseases in Health Insurance?

There is no fixed waiting period for heart disease in health insurance. The waiting period depends on whether the heart problem is newly developed, pre-existing or covered under a critical illness plan.

Here is a brief overview of the waiting period for different heart conditions:

Waiting Period for Coronary Artery Disease (CAD)

Coronary Artery Disease (CAD) is caused by damaged, hardened or blocked arteries. 

• If it is a new condition – covered after 30 days
• If it is linked to an existing condition – covered after 1-3 years

Waiting Period for Bypass Surgery

• If required because of a new health condition – covered after 30 days
• If required because of an existing condition – treated as a PED, covered after 1-3 years
• If covered under a critical illness plan – covered after 90 days and a survival period of 30 days applies

Waiting Period for Heart Valve Problems

• If it is a new diagnosis – covered after 30 days
• If it is an existing condition – covered after 1-3 years
• Major heart valve replacement surgery may be covered under critical illness and covered after 90 days. It may also have a survival period of 30 days.

Waiting Period for Heart Attack

• If there were no symptoms before buying the policy – covered after 30 days
• If the condition existed or was diagnosed before buying the policy – PED applies, covered after 1-3 years
• Under critical illness plans, it is covered after 90 days and has a survival period of 30 days.

Waiting Period for Congenital Heart Disease

These are the heart problems or defects present since birth. Hence, these are usually considered as pre-existing conditions and a PED waiting period of 1-3 years applies.

Waiting Period for Angina 

It refers to chest pain or discomfort caused by reduced blood flow.

• If it is diagnosed after buying the policy, it is covered after 30 days.
• If it is diagnosed before buying the policy, it is covered after 1-3 years.

Waiting Period for Arrhythmia (Irregular Heartbeats)

• If it has developed after buying health insurance, it is covered after 30 days
• If it existed before buying health insurance, it is considered a PED and covered after 1-3 years

What is the Waiting Period for Cancer in Health Insurance?

The waiting period for cancer depends on whether it developed before or after buying the policy.

• If the symptoms first develop after buying the policy:
• An initial waiting period of 30 days applies in case of regular health insurance plans.
• An initial waiting period of 90 days applies under a critical illness plan. It is to be noted that coverage under a critical illness plan may depend on the stage of cancer.
• If it is linked to a health condition that existed before buying the policy, the PED waiting period of 1-3 years applies.
• Some insurers also provide cancer-specific plans. These usually have a 90-day waiting period and cover both early- and advanced-stage cancers.

For people who have already been diagnosed with cancer, the waiting period may be longer or the policy may not provide coverage for the condition, depending on the individual case.

What is the Waiting Period for Diabetes and BP in Health Insurance?

• If diabetes or BP is diagnosed after buying health insurance, an initial waiting period of 30 days applies.
• If diabetes or BP was diagnosed before buying the plan, a PED waiting period of 1-3 years applies.

If the insured has diabetes or BP, related complications, such as kidney disease, eye damage, nerve damage, cardiovascular problems, etc., may be treated as a PED (depending on the insurer’s assessment) and a PED waiting period may apply.

Disclaimer: Coverage depends on policy terms, medical history, lifestyle habits, etc. Read your policy wording carefully to know the exact coverage.

Is it Possible to Reduce the Waiting Period in Health Insurance?

Yes, it is possible to reduce the waiting period in a health insurance policy. Several insurance companies offer the option to reduce the waiting period for pre-existing diseases and specified illnesses/procedures with the reduction in waiting period cover. Moreover, some health plans offer PED coverage from day 1 or day 30 of the policy. However, such covers can be purchased by paying an extra health insurance premium.

For example, several medical insurance plans come with a reduction in the PED waiting period optional cover to reduce the waiting period for such diseases from 3 years to 2 years or 1 year.

Specific Diseases Waiting Period

The specific disease waiting period duration varies across health insurance plans. While IRDAI guidelines allow the specific illness waiting period to be up to 3 years, most insurers offer plans with a shorter waiting period of 1-2 years.

Some of the common conditions included under specific diseases/procedures include (but are not limited to) the following: 

It is to be noted that the list of specific illnesses/procedures varies across plans. Hence, the insured must read the policy wording carefully to ensure that the chosen plan covers them.

Critical Illness Waiting Period

Critical illnesses are covered after 90 days from policy issuance and usually include a survival period of 30 days. This means that for the claim to be paid, the insured must survive for at least 30 days after the diagnosis of their critical illness.

Here is a list of health conditions that usually fall under critical illnesses:

Another important thing to remember is that waiting periods for specific diseases and critical illnesses apply only if the condition is diagnosed first after the policy is purchased. If it has been diagnosed before the policy purchase, it will be treated as an existing condition and the PED waiting period will apply to it.

Cooling Off Period in Health Insurance

Many people confuse the cooling off period in health insurance with the waiting period, but they are different. The cooling-off period is the time period after recovering from a medical condition that a person must wait before purchasing a mediclaim policy. Health insurance companies use this period to assess the risk of recurrence of the disease before providing medical coverage.

For example, if an elderly person has recently recovered from cancer, insurers may impose a cooling-off period ranging from a few days to a couple of months, depending on the patient's condition and their underwriting policy. During this time, the person cannot buy a new senior citizen health insurance policy or may have to undergo additional medical tests before the insurer decides on coverage terms.

Things to Keep in Mind About the Waiting Period in Health Insurance

Take a look at the things to keep in mind about the waiting period in health insurance:

• If the insured is diagnosed with a disease for the first time during the waiting period, it will not be called a pre-existing disease. In such a case, the insurer will cover the ailment.
• Zero waiting period in health insurance is available for accidental claims. 
• When switching insurers, the waiting period already served may be credited to the new policy, as per the health insurance portability guidelines of the Insurance Regulatory and Development Authority of India (IRDAI).
• Different mediclaim policies have varying waiting periods for the same coverage.
• Always check the policy document before buying medical insurance to know the exact waiting periods applicable.